Naito Jun, Toyoda Takahide, Nakajima Takahiro, Fujiwara Taiki, Iwasawa Shunichiro, Suzuki Hidemi, Takiguchi Yuichi, Yoshino Ichiro
Departments of General Thoracic Surgery.
Respiratory Medicine.
J Bronchology Interv Pulmonol. 2019 Apr;26(2):129-131. doi: 10.1097/LBR.0000000000000571.
Since the development of third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for lung cancer treatment, the need for a rebiopsy has increased. To select an appropriate therapeutic regimen, the genetic alterations in cancerous tissue should be determined. A rebiopsy plays an important role in the treatment of patients with diseases that are refractory to the previous generation of EGFR tyrosine kinase inhibitors. Cell-free DNA-based exploration is useful for determining the cause of treatment resistance in cases in which a rebiopsy is difficult; however, this method cannot detect histologic changes (a mechanism of resistance), which may lead to the selection of nonoptimum therapeutic agents. We herein report a case in which EGFR mutation-positive (exon 19 deletion) lung cancer was successfully treated with an appropriate chemotherapeutic regimen after disease progression. The regimen was selected based on the precise evaluation of a rebiopsy specimen, which determined the histologic type and detected a gene mutation.
自从用于肺癌治疗的第三代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂问世以来，再次活检的需求有所增加。为了选择合适的治疗方案，应确定癌组织中的基因改变。再次活检在治疗对上一代EGFR酪氨酸激酶抑制剂难治的疾病患者中起着重要作用。基于游离DNA的探索对于确定难以进行再次活检的病例中的治疗耐药原因很有用；然而，这种方法无法检测到组织学变化（一种耐药机制），这可能导致选择非最佳治疗药物。我们在此报告一例病例，其中EGFR突变阳性（外显子19缺失）的肺癌在疾病进展后通过适当的化疗方案成功治疗。该方案是根据对再次活检标本的精确评估选择的，该评估确定了组织学类型并检测到基因突变。
